Patient-Clinician Communication and Needs Identification for Outpatients with Schizophrenia in Hong Kong: Role of the 2-COM Instrument

Article excerpt

Abstract

Objectives: To assess perceived needs of schizophrenic outpatients in Hong Kong, and the effectiveness of clinicians in identifying those needs; and to explore the use of a self-rated instrument to enhance needs identification.

Participants and Methods: The two-way communication checklist was completed by 70 outpatients before consultation. Their clinicians were either given the checklist during the consultation (2-COM group, n = 36), or were unaware of the patients' answers and independently completed the checklist (needs awareness group, n = 34). A standard care group (n = 35) was included for comparison. Consultation time and patient satisfaction were also recorded.

Results: The major concern of patients was information about their illness and treatment (59%). In the needs awareness group, under-recognition of patients' needs by clinicians was observed in various domains. Consultation time (mean, 5.6 minutes) correlated with the number of needs identified by clinicians. The 2-COM group showed a trend towards higher satisfaction compared to the standard care group, although this did not reach statistical significance.

Conclusions: Clinicians may under-identify problems perceived by patients due to time constraints and other factors. The use of a structured questionnaire may facilitate effective needs identification in a busy outpatient clinic.

Key words. Communication; Needs assessment; Physician patient relations; Psychotic disorders; Questionnaires

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Introduction

Schizophrenia may be accompanied by longstanding and pervasive disabilities affecting many different life domains. Adequate communication between patients and professionals is essential for its diagnosis and treatment. Accurate needs assessment is a prerequisite for treatment planning (1) and effective service delivery. (2,3)

Previous studies revealed that patient participation plays an important role in the success of clinical management. (4) However, there are discrepancies between patients' and professionals' perceptions of what constitutes 'needs'. (2,3,5-7) Such discrepancies may impact negatively on patient outcomes and quality of life. (6,8) In particular, empirical studies have suggested that clinicians substantially under-recognise the needs of patients. (9)

In Hong Kong, as in many other parts of Asia, mental health services largely rely on outpatient clinics. The clinician-patient ratio is relatively low, when compared to many western countries. Service is often delivered in consultations that last for only a few minutes and is predominantly focused on medications and related issues. (10) Owing to time constraints, patients may find it difficult to raise broader issues relevant to their health. Professionals may therefore be limited in their capacity to evaluate patient needs comprehensively. This problem may be particularly serious in patients with schizophrenia, who are less capable of presenting their own needs. (11) There have been few reports on the extent and nature of these problems in an Asian context.

In western countries, mental health care is becoming more and more needs-led, with an emphasis on a systematic approach to needs assessment. (12) A number of standardised scales have thus been developed, each with its merits and areas of focus. These include interview-based scales for use by trained investigators, such as the Camberwell Assessment of Need (CAN (13)), MRC Needs for Care Assessment Schedule, (14) the Cardinal Needs Schedule, (15) and the Perceived Need for Care Questionnaire (16); as well as self-reporting instruments such as the 2-way communication checklist (2-COM (17)) and the Avon Mental Health Measure. (18)

When considering applications to improve clinical service in an outpatient setting, cost-effectiveness is an important factor. The use of self-reporting instruments provides a simple solution to facilitate routine outpatient care, (17) and could potentially become a low-cost, yet effective means of improving patient-clinician communication. …